Virtual reality in pain therapy: a requirements analysis for older adults with chronic back pain

Background Today immersive environments such as Virtual Reality (VR) offer new opportunities for serious gaming in exercise therapy and psychoeducation. Chronic back pain (CBP) patients could benefit from exergames in VR. The requirements in older CBP patients for a VR pain therapy have not yet been determined in studies. The aim of the study was to perform a requirements analysis for the user group of geriatric patients with CBP for a VR exergame. The objective was to find out the expectations, desires, preferences and barriers in order to collect them as requirements for this vulnerable group and to determine frameworks of therapy by physiotherapists and psychotherapists. Methods We conducted a requirements analysis through semi-structured interviews with 10 elderly participants with CBP. Furthermore, two focus groups were conducted with three physiotherapists and two psychotherapists to determine frameworks of therapy programs for the target group. The qualitative data were transcribed and examined through a structuring content analysis. Subsequently, the results of the analysis were prioritized by all participants of the study. Results The results of the requirements analysis indicate mandatory requirements for the overall system, hardware, software and gamification elements. The key requirements were target-group-specific applications of the VR exergame through e.g. individual briefing, user-friendly handling, inclusion of movement limitations, presentation of everyday scenarios in combination with biofeedback, age-appropriate feedback through praise and awards and a maximum exercise duration of 30 min and 15 min of relaxation. Conclusion It should be possible to use the determined requirements productively to create user-friendly VR exergames that motivate elderly chronic back pain patients to perform exercises regularly. Trial registration The study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00015294 12.10.2018).

For Example:

Games for the ViRST-System
1.1 How do you evaluate the importance of the following groups of experts in relation to the games?
1.2 Please rate the requirements according to your subjective importance through placing ranks.
Since there are only 5 requirements in the dimension "Games for the ViRST-System", there are only 5 ranks to be assigned.

ViRST Prioritization of the requirements
The purpose of this document was to prioritize the requirements for the ViRST system (Virtual Reality for pain therapy) that have been raised by chronic back pain patients and experts (physiotherapists and psychotherapists). The following summary shows the results of the prioritization of 6 CBP patients, 3 physiotherapists and one psychotherapist.
The stakeholders were asked to answer the following questions by putting them in an order using grades (e.g. 1, 2, 3, 4 etc.) The easiest way is to assign the ranks one after the other. Thereby the number zero ("0") cannot be assigned to any order. Rank 2 3. The system should provide card games.
Rank 5 4. The system should provide board games.
Rank 3 5. The system should provide puzzle games.
Rank 1 1. How do you evaluate the importance of the following group of experts regarding the overall project on chronic back pain therapy using virtual reality?

Results:
Handling The system should be easy to handle. Rank

1
The system should be used standing up. Rank

2
The system should be used in a seated position. Rank

3
The system should not replace conventional therapy.

3
The system should only be offered to patients without cognitive impairment.
Rank 5 The system should be operated by hands. Rank

6
The view should be stabilized when the glasses are shaking. Rank

7
The system should only be offered for chronic patients without movement limitations.

Duration
The system should offer breaks between the exercises.
Rank 1 The exercises should last 30 minutes maximum. Rank 2 The system should offer a 15 minute relaxation sequence. Rank 3 The system should offer a 30 minute relaxation sequence. Rank 4 The system should not offer breaks between the exercises Rank 5 Instructions/Briefing The system should offer an individual briefing. Rank 1 The system should offer a tutorial for the right handling.
Rank 2 The briefing should be conducted by personal assistance. Rank 3 The system should show the amount of correct motions respectively Rank 4 The system should offer alternatives for exercises.
Rank 5 The patient has to be instructed. Rank 6 The system should have an instruction manual. Rank 7 The system should lead to a correct posture.
Rank 8 The performance with the system should take place under the supervision of Rank 9 The exercises should be executed under a personal instruction.

Security/ Dataprotection
The system should be used at a safe place with sufficient space.
Rank 1 The system should allow one to sit down. Rank 2 The system should have a help button. Rank 3 The data security must be given. Rank 4 The system should not involve twists during the exercises. Rank 5

Price/ Funding
The system should be for rent. Rank 1 The system should be up for loan. Rank 2 The system should cost < 100€. Rank 3 The system should cost < 50€. Rank 4 The system should be purchased by a one time payment.

Results:
The patient should be able to put on the goggles by himself. Rank 1 The goggles should be put on and off easily.
Rank 2 The controller should be lightweight.
Rank 3 The goggles should be lightweight.
Rank 4 The controller must lay in the hands conveniently.
Rank 5 The goggles should fit appropriately (without a chink of light and not too tight).
Rank 6 The foam of the goggles must be exchangeable due to hygiene reasons.
Rank 7 The goggles should have a manual focus adjustment. Rank 8 The controller must be differentiable.
Rank Results:

Environment
The system should undertake an individual calibration (for the detection of restriction of motion).

Rank 1
The system should have a virtual instructor.
Rank 2 The System should offer a selectable environment (e.g. green meadow, colorful characters).

Rank 3
The virtual instructor should be a chronic back pain patient who describes his/her story of suffering and positive experiences.

Rank 4
The system should represent nature as an environment (e.g. forest, flower garden, water).

Rank 5
The system should offer a gymnasium as an environment. Rank 6 The system should not stereotype. Rank 7 The system is supposed to offer fairy tale environments.

Application
The system should enable the therapist to intervene on patients (pain, anxiety, misperformance).

Rank 1
If the scores become worse, the physiotherapist should intervene and include the errors in the conventional therapy.

Rank 2
The system should know the limitations / key figures of the patient (e.g. max. width of the stretch, height, weight).

Rank 3
The system should query the VAS scale (even at longer intervals). Rank 3 The system shall perform a more detailed assessment after the VAS scale has been queried.
Rank 5 The software should give safety instructions. Rank 6 The graphics of the software should be high-resolution. Rank 7 The system should display players as avatars.

Exercise
The system should perform everyday exercises. Rank 1 The system should contain aerobic exercises (for the perception of the body).

Rank 2
The system should offer mobilization exercises. Rank 3 The system should display in the therapist view the duration of the exercises performed.

Rank 4
The system should offer environments for men (e.g. adventure) and women (e.g. flowers).

Rank 5
The system should not be used for everyday exercises.
Rank 6 5. Gamification / Game integration 5.1 How do you evaluate the importance of the following stakeholders regarding the gamification?